Dual College / Dual Certification Initiative

Please Note: The first item below is a CAEP Dual College/Dual Certification Working Group working paper, and not a CAEP position statement.

Compelling Reasons for Change in EM Training in Canada Updated May 2013 FINAL.

Click here for the Dual College / Dual Certification Historical Timeline Document in pdf format

Member Update on the Collaborative CAEP/CFPC/RCPSC Working Group on the Future of Emergency Medicine in Canada
 

April 4, 2013

In July of 2012 the Canadian Association of Emergency Physicians (CAEP), the College of Family Physicians of Canada (CFPC), and the Royal College of Physicians and Surgeons of Canada (RCPSC) announced the formation of a Collaborative Working Group on the Future of Emergency Medicine in Canada. The announcement was mailed to all 1874 members of CAEP, and stated that during a meeting between CAEP, the CFPC and the RCPSC held in May of 2012, there was agreement that:

  • The prime objective shared by all three organizations is to ensure that high quality emergency medical care is provided for patients presenting to emergency departments throughout Canada.
     
  • While the current system, with both the CCFP and the RCPSC certifying emergency physicians has served Canada well, challenges exist related to health human resources, education and training of future emergency physicians that must be addressed if we are to continue to meet the evolving health care needs of Canadians.
     
  • While the current Emergency Medicine training and certification programs of both the CFPC and the RCPSC will remain in place to meet their respective training objectives, there will be an exploration of identified areas where they may collaborate and adapt to enhance efficiency and/or effectiveness in the realization of shared objectives in order to maximize the benefits that each of these programs bring to patient care and emergency physician career satisfaction.

The Collaborative Working Group, led by and reporting to CAEP, the CFPC, and the RCPSC, was to be established by September 15, 2012 to address the challenges articulated above, and was to provide a written report with recommendations to the three organizations by May 15, 2013.

In December of 2012, after a November letter from CAEP expressing concerns about delays in the formation of the Collaborative Working Group, CAEP received a letter from the CEOs of the CFPC and RCPSC indicating that they had commenced a larger project that would focus on the shared responsibility of the two Colleges for the education and training of family physicians with enhanced skills and Royal College certified specialists in a number of clinical areas. The CFPC and RCPSC indicated to CAEP that further meetings would be needed between the Colleges in the first quarter of 2013, and that a new CFPC/RCPSC/CAEP working group process would begin in or around April of 2013. As a result of these circumstances, the previously announced Collaborative Working Group has not yet been struck.

CAEP remains deeply committed to partnering with both the CFPC and the RCPSC to improve the future of Emergency Medicine in Canada. We will continue to provide updates on the status and progress of this important initiative as the details emerge from the CFPC and RCPSC.

Bruce McLeod, MD, FRCPC
President, Canadian Association of Emergency Physicians

Chris Evans, MD
Chair, Dual College/Dual Certification Working Group
 

CAEP Board approved vision and principles for the Dual College/Dual Certification Working Group

“CAEP’s vision is that of a new single Emergency Medicine residency program that would incorporate the best features of both the College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) Emergency Medicine Residency Training Programs to train both clinical and academic emergency physicians in a coordinated, efficient, and effective manner.“

In addition, the CAEP Board has endorsed a set of high level program development principles developed by the Dual College/Dual Certification Working Group and vetted by the Montreal Task Force members:
 
1. That CAEP’s goal is a single Emergency Medicine clinical certification stream followed by an optional fellowship year or years for those with subspecialty inclinations
 
2. That funding that currently exists for Emergency Medicine training programs in either the CFPC or RCPSC programs be retained within the envelope of Emergency Medicine residency training. This principle does not preclude movement of funding from one program to another or to an entirely new program.
 
3. That CAEP has no preconceived notions in relation to what College or Colleges will/should manage Emergency Medicine residency training.
 
4. That no matter what the outcome of this process, Emergency Medicine needs to continue to be a specialty like all others in Canada.


June 1, 2012 - Communication to members

On May 16, 2012, representatives from the highest administrative levels of CAEP, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada met in Ottawa to discuss EM training and certification in Canada. At the meeting, neither College expressed the desire to pursue a unified EM training stream at this time. There was, however, acknowledgement that challenges specific to each of the two EM training streams and their roles and interrelationship have evolved over time. In order to address these issues, the parties agreed to form a trilateral working group on the future of Canadian EM training and emergency physician health human resource requirements. In the near future, a joint statement from all three parties will outline what was agreed upon in more detail. We view this meeting, and the commitment of the CFPC and RCPSC to work collaboratively with CAEP in shaping the future of emergency medicine training and emergency physician health human resources, as a significant accomplishment and an historic milestone in the evolution of Emergency Medicine in Canada.

Respectfully,

Chris Evans MD, DC/DC WG Chair
Peter Toth MD, CCFP (EM), CAEP President


February 15, 2012

Update on the Dual College – Dual Certification CAEP Board Initiative

Dear member,

We are writing to give you an update on the Dual College – Dual Certification (DC/DC) CAEP initiative.  We believe it is important for the membership to remain apprised of, and engaged in, CAEP’s efforts on this important issue.

Over the past 6 months there has been ongoing communication between CAEP and representatives of both Colleges, and specific initiatives, both within and external to the Colleges, have us feeling guardedly optimistic.  Some of the history of the DC/DC initiative is outlined below, following which is an update on more recent developments.

As has been previously communicated, on May 26, 2011, CAEP representatives Drs. Peter Toth, Riyad Abu-Laban and Mary-Lynn Watson met in Ottawa with representatives from the College of Family Physicians of Canada (Dr. Constance LeBlanc and Dr. Paul Rainsberry) and the Royal College of Physicians and Surgeons of Canada (Dr. Brian Holroyd and Dr. Ken Harris), to engage the Colleges in discussions regarding how Canadian emergency medicine training and certification could be improved.

During that meeting, there was a wide ranging discussion around CAEP’s concerns with the status quo regarding EM training and certification in Canada.  At the end of the meeting, there was agreement from both Colleges to gather further information from their respective EM Residency Program Directors and to participate in a coordinated effort with CAEP to conduct a rigorous and comprehensive national opinion survey on this topic involving certificants and trainees from the RCPSC EM and the CFPC EM programs.

On June 5, 2011 at the CAEP Conference in St. John’s, the Montreal Task Force (MTF) members met and were updated on the discussions between CAEP and the Colleges.  Dr. Peter Toth also attended the RCPSC EM Specialty Committee meeting and the CFPC EM Practice Committee meeting to hear the perspectives of the Program Directors.  At the AGM on June 6, an update was provided and some CAEP members asked questions about the CAEP’s activities and future plans in relation to the DC/DC issue.

Over the past year there has been an unprecedented level of communication between CAEP and the two colleges, and between the two colleges themselves, regarding the EM training situation.  In addition, CAEP recently provided feedback to an important Health Canada initiative titled the Future of Medical Education in Canada Postgraduate Project (FMEC PGP) that highlighted the issues with EM training in Canada, and supported draft recommendations calling for better inter-college coordination and communication to address the blurring of borders among specialties and potential redundancies.  As a result of our feedback, as well as that of other stakeholders, the second iteration of the FMEC PGP draft recommendations have been further refined, and are now even more supportive of changes that may lead to a resolution of the issues with the EM training situation in Canada.  The Dual College / Dual Certification Working Group continues to meet on a regular basis in order to formulate strategy relating to advancing CAEP’s postgraduate EM training Vision and Principles (see link below).  We are now in the process of arranging a meeting with representatives at the highest levels from both Colleges with the goal of determining next steps and continuing dialogue with them on this issue.

The CAEP Board remains committed to the DC/DC process and to working with the CFPC and RCPSC on this extremely important issue.

CAEP welcomes and encourages membership feedback on this topic.  Please feel free to email us at DC/DC Feedback.  More information about the DC/DC process can be found on the CAEP website.

Chris Evans MD – Chair, Dual College / Dual Certification Working Group

Peter Toth, MD, CCFP EM – CAEP President

CAEP Board approved vision and principles for the Dual College/Dual Certification Working Group

Montreal Task Force Report

Members of the Montreal Task Force


June 3, 2011

Dear CAEP Member,

In response to the 2009 CAEP member survey on Emergency Medicine training and certification, and the subsequent 2010 determinations of the 20 member Montreal Task Force (MTF) on Emergency Medicine training and certification, CAEP representatives Drs. Peter Toth, Riyad Abu-Laban and Mary-Lynn Watson met with representatives from the College of Family Physicians (CFPC) of Canada and the Royal College of Physicians and Surgeons of Canada (RCPSC) in Ottawa on May 26, 2011.

The purpose of this historic meeting was to engage the two Colleges in discussions around how Canadian emergency medicine training and certification could be improved given the MTF determination that, in the words of the chair Dr. Doug Sinclair, “there was broad support for the concept that the status quo was not acceptable, and the existence of two training programs did not serve the current and future needs of the Emergency Medicine community, the specialty of Emergency Medicine, and the citizens of Canada”.

A wide ranging discussion took place over the 2 hour meeting. The CAEP representatives brought forward to the CFPC and RCPSC a historical review, as well as their perspectives on our member survey and the recommendations of the Montreal Task Force that were unanimously supported by the CAEP Board of Directors. Both Colleges raised concerns about the validity of the CAEP member survey results and the MTF determinations, and whether issues of sufficient magnitude to warrant change truly existed with the current Canadian Emergency Medicine training and certification system. There was agreement from the Colleges to gather further information from their respective residency program directors and to participate in a coordinated effort with CAEP to conduct a more rigorous and comprehensive national survey.

CAEP will be convening a meeting with the MTF members at the upcoming CAEP Conference in St. John’s in order to seek their input at this juncture. CAEP would also welcome feedback from the membership on this important topic. Please feel free to email CAEP at dc-dcfeedback@caep.ca.

Chris Evans MD – Chair, Dual College / Dual Certification Working Group

Peter Toth, MD, CCFP EM – CAEP President


Update on the Montreal Task Force on Emergency Medicine Training in Canada

March 21, 2011

As you know, CAEP convened a Task Force on Emergency Medicine training in Canada on May 30th, 2010 at CAEP’s last Annual Conference in Montreal. The Montreal Task Force (MTF) included twenty leaders in Emergency Medicine, the majority of whom were elected by the CAEP membership.

The MTF was chaired by Dr. Doug Sinclair, and his report stated the following:

“There was broad support for the concept that the status quo was not acceptable, and the existence of two training programs did not serve the current and future needs of the Emergency Medicine community, the specialty of Emergency Medicine, and the citizens of Canada.”

“The Task Force felt that CAEP should take the lead on initiating a process that would result in a more optimal approach to the training of emergency physicians in Canada. Both the Royal College and the CFPC will need to be key partners, since they are the only bodies that can accredit postgraduate training in Canada.”

The full MTF report and a list of the MTF members are available on the CAEP website.

As a result of the findings of the Montreal Task Force, last fall the CAEP Board struck the CAEP Dual College/Dual Certification Working Group. The Working Group consists of the following CAEP members:

Chris Evans MD – Chair, Dual College / Dual Certification Working Group
Peter Toth MD CCFP EM – CAEP President
Riyad Abu-Laban MD, FRCPC
Brian Holroyd MD, FRCPC
Tim Rutledge MD, CCFP EM
Mary-Lynn Watson MD, CCFP EM

The Working Group has been tasked with advancing the process envisioned by the Montreal Task Force members. The Dual College/Dual Certification Working Group has met a number of times, and has engaged the College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) at the highest levels. The CAEP Board has endorsed a vision, developed by the Dual College/Dual Certification Working Group and vetted by the Montreal Task Force, for the future of Emergency Medicine training in Canada:

“CAEP’s vision is that of a new single Emergency Medicine residency program that would incorporate the best features of both the College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) Emergency Medicine Residency Training Programs to train both clinical and academic emergency physicians in a coordinated, efficient, and effective manner.“

In addition, the CAEP Board has endorsed a set of high level program development principles developed by the Dual College/Dual Certification Working Group and vetted by the Montreal Task Force members:

1. That CAEP’s goal is a single Emergency Medicine clinical certification stream followed by an optional fellowship year or years for those with subspecialty inclinations

2. That funding that currently exists for Emergency Medicine training programs in either the CFPC or RCPSC programs be retained within the envelope of Emergency Medicine residency training. This principle does not preclude movement of funding from one program to another or to an entirely new program.

3. That CAEP has no preconceived notions in relation to what College or Colleges will/should manage Emergency Medicine residency training.

4. That no matter what the outcome of this process, Emergency Medicine needs to continue to be a specialty like all others in Canada.

It is anticipated that this spring, representatives from the CFPC, the RCPSC and CAEP will be meeting at the CAEP Head Office in Ottawa to discuss how we might move forward. The CAEP Board is very committed to this process, as we have clearly heard from Canada’s emergency physicians that the status quo is not ideal. CAEP will continue to engage and work with the CFPC and RCPSC on this extremely important issue.

Chris Evans, MD, Chair, Dual College/Dual Certification Working Group

Peter Toth, MD CCFP EM
CAEP President


Montreal Task Force Report

Emergency Medicine Training in Canada

Introduction

The Montreal Task Force was brought together by the CAEP Board of Directors to consider three questions with respect to Emergency Medicine (EM) training in Canada. The composition of the Task Force was carefully considered by the CAEP Board, and the ultimate structure of the Task Force was intended to represent the broad membership of CAEP. All non-appointed Task Force members (12 out of 20 total task force members) were elected by the CAEP membership via an election process. Extensive background information was assembled for review and discussion. The Task Force was chaired by Dr. Doug Sinclair, and the two hour meeting was very productive. Representatives from the College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) were in attendance. The membership of the Task Force is attached as Appendix 1.

Question #1: Does the existing Emergency Medicine training and certification system in Canada, with two independent routes to certification run by two colleges, best serve the current and future needs of the emergency medicine community, the specialty of emergency medicine, and the citizens of Canada?

There was broad support for the concept that the status quo was not acceptable, and the existence of two training programs did not serve the current and future needs of the emergency medicine community, the specialty of emergency medicine, and the citizens of Canada.

It was felt by the group that a renewal of educational programs would enhance the standards of care for emergency medicine in all settings. It was recognized that family physicians will continue to deliver a significant proportion of emergency care and the specialty should support their ongoing continuing professional development. It was felt that the existence of two training programs, with EM certification by two colleges, leads to dilution of the political will to move EM forward and creates ongoing cultural barriers. Each training program has strengths and weaknesses that could be enhanced.

It was also recognized that there are risks associated with moving away from the status quo. It appears that the Royal College is interested in new models, but that the College of Family Physicians of Canada has significant concerns about any changes to the current structure. The need for advanced fellowship training in subspecialty areas will need to be protected and enhanced in any new process. Any new program will need to ensure that academic leaders continue to be trained and mentored.

Question #2: If no, should CAEP initiate and lead a process to attempt to improve the system?

The Task Force felt that CAEP should take the lead on initiating a process that would result in a more optimal approach to the training of emergency physicians in Canada. Both the Royal College and the CFPC will need to be key partners, since they are the only bodies that can accredit postgraduate training in Canada. CAEP will need to be a leader and strong advocate to move this agenda forward. Other key partners identified during the discussion include the provincial sections of Emergency Medicine, which have variable interest in this subject at the present time.

Question #3: If so, what process might best lead to success, and what are the next steps?

The Task Force recognized that there are many issues to consider as this important project moves forward. Our Task Force did not have time at our short meeting to consider the details of new training models, but did discuss a number of principles that would meet the diverse needs of the current and future EM community.

The key steps for the CAEP Board of Directors will be:

Respectfully Submitted,
Doug Sinclair MD, CCFP(EM), FRCPC, Chair, Montreal Task Force
Past President - CAEP-1999-2001
June 2010


Members of the Montreal Task Force

Defined - Chair, an emergency physician with both CCFP(EM) and RCPSC certification: Doug Sinclair, MD, CCFP(EM), FRCPC
Defined - CAEP President: Chris Evans, MD
Defined - 2 CAEP Board Representatives: Peter Toth, MD, CCFP(EM) & Bruce McLeod, MD, FRCPC
Defined - CJEM Editor-in-Chief: Jim Ducharme, MD, FRCPC, ABEM
Elected - 1 Clinical ED Chief: Michael Ertel, MD, CCFP(EM)
Elected - 1 Academic (University) EM Department or Division Chair: Philip Yoon, MD, CCFP(EM)
Elected - 1 RCPSC EM Residency Director: Wesley Palatnick, MD, FRCPC, ABEM
Acclaimed - 1 CFPC EM Residency Director: Neil Collins, MD, CCFP(EM)
Appointed - 1 representative from the RCPSC - Chosen by the RC: Brian Holroyd, MD, FACEP, FRCPC
Appointed - 1 representative from the CFPC - Chosen by the CFPC: Constance LeBlanc, MD, CCFP(EM)
Elected - 1 resident from an RCPSC EM program: James Huffman, MD
Acclaimed - 1 resident from a CFPC EM program: Daren Lin, MD
Defined - 1 Canadian medical student with an interest in EM as a career: Elected Chair of the Medical Student Subsection - Morgan Riggan, Medical Student
Elected - 3 at large RCPSC EM certificants, 1 of whom has been certified within the last 3 years.

Elected - 3 at large CFPC EM certificants, 1 of whom has been certified within the last 3 years.


March 5, 2010 Email Sent To CAEP Members Regarding The Process Around The Montreal Task Force

Dear CAEP member,

CAEP will be convening a Task Force to meet at the Hilton Montreal Bonaventure on Sunday May 30, 2010 from 10 am to 12 noon to consider the following resolution passed at the November 17, 2009 CAEP Board meeting:

"CAEP supports a re-evaluation of emergency medicine training and certification in Canada."

The Montreal Task Force will be asked to answer the following three questions:

1.    Does the existing EM training and certification system in Canada, with two independent routes to certification run by two colleges, best serve the current and future needs of the emergency medicine community, the specialty of emergency medicine, and the citizens of Canada?

2.    If no, should CAEP initiate and lead a process to attempt to improve the system?

3.    If so, what process might best lead to success, and what are the next steps?

The composition of the Montreal Task Force will be as follows:

1 EP with both CCFP (EM) and RCPSC certification (CHAIR)

CAEP President

2 CAEP Board Representatives

CJEM Editor-in-Chief

1 Clinical ED Chief

1 Academic (University) EM Department or Division Chair

1 RCPSC EM Residency Director

1 CFPC EM Residency Director

1 representative from the RCPSC

1 representative from the CFPC

1 resident from an RCPSC EM program

1 resident from a CFPC EM program

1 Canadian medical student with an interest in EM as a career

3 at large RCPSC EM certificants at least one of whom has been certified within the last three years

3 at large CFPC EM certificants at least one of whom has been certified within the last three years

The CAEP Board has appointed Dr. Doug Sinclair, a Past President of CAEP, as the Chair of the Montreal Task Force.

The RCPSC and CFPC representatives will be selected by their respective organizations.  The Medical Student with an interest in EM will be the elected chair of the Medical Student's Subsection, Andrew Petrosoniak.  The 2 CAEP Board members will be selected by the CAEP Board; the CAEP President is Dr. Chris Evans and the CJEM Editor-in-Chief is Dr. James Ducharme.  The resident representatives will be elected by the members of the CAEP Resident's Section. All other members of the Montreal Task Force will be elected by the CAEP membership.

If you are interested in becoming a member of this Task Force, please submit your name, the position you are interested in running for, a statement (maximum 150 words) explaining why you feel that the emergency medicine community should elect you as a member of the Task Force, and a one page CV suitable for distribution to the CAEP membership to: <mailto:admin@caep.ca>admin@caep.ca

The deadline for submission is Monday March 15, 2010.

Please note:

The election will be held via a web based vote beginning March 22, 2010, and voting will be closed April 5, 2010.  The election results will be circulated on April 8, 2010.  Further details will be provided as they are finalized.

Sincerely,

Chris Evans, MD

President

  • The prime objective shared by all three organizations is to ensure that high quality emergency medical care is provided for patients presenting to emergency departments throughout Canada.
     
  • While the current system, with both the CCFP and the RCPSC certifying emergency physicians has served Canada well, challenges exist related to health human resources, education and training of future emergency physicians that must be addressed if we are to continue to meet the evolving health care needs of Canadians.
     
  • While the current Emergency Medicine training and certification programs of both the CFPC and the RCPSC will remain in place to meet their respective training objectives, there will be an exploration of identified areas where they may collaborate and adapt to enhance efficiency and/or effectiveness in the realization of shared objectives in order to maximize the benefits that each of these programs bring to patient care and emergency physician career satisfaction.
    • Articulation of a clear vision for educational programs in emergency medicine to be achieved within a defined time line
    • Development of a set of principles to guide the program development
    • Early engagement of key partners, including the RCPSC, CFPC, and provincial sections of EM
    • Utilize the Task Force membership in this important work, with CAEP Board direction and head office support.
    • Trevor Langhan, MD, FRCPC (certified within the last 3 years)
    • Riyad Abu-Laban, MD, FRCPC, ABEM
    • Jill McEwen, MD, FRCPC
    • Jan Sommers, MD, CCFP(EM), BScPT (certified within the last 3 years)
    • Mary-Lynn Watson, MD, CCFP(EM)
    • Jock Murray, MD, CCFP(EM)
    • Only CAEP members are eligible to run for a position on the Montreal Task Force.
    • CAEP will not provide funding for participation in (or travel to) the Montreal Task Force. Members of the Task Force may participate by teleconference if unable to attend in person.
    • An individual may run for one position only.
    • If more than six individuals apply to run for any one position, six names will be randomly selected from the list of all who applied for that position to be on the election slate.  This is to limit the size of the potential slate of applicants to a reasonable number in the event that we have overwhelming interest in participating on the Task Force.
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